THE ACCURACY OF PRESSURIZED METERED DOSE INHALERS IN PATIENTS WITH PULMONARY DISEASE: AN IMPROVEMENT PROJECT IN TAIWAN

Hui-Tzu Lin* 1, Jui-Yuan Su1, Hsin-Chun Wang1, Yu-Shang Chen1, Han-Ying Tsai1, Chen-Chun Liu1, Ching-Hui Wang1

1Nursing Department, Veterans General Hospital, Taipei, Taiwan

Introduction: The inhaled route to administrate medicine as pressurized metered-dose inhalers (pMDI) is considered to be the best route for safety and efficacy. The inhaled device operation error is about 50%. The cause of lack of accuracy which may affect the efficacy of drug therapy causing complications is difficulty remembering the operation steps, complex operation skills, lack of awareness of nurses on the operation of pMDI, lack of implementation of drug guidance, and patients not receiving training.

Methods: To improve drug safety and self-care efficiency, multi-professional members formed a task force. The checklist for the Correctness of pMDI Operation for patients was developed. In February 2022, the patients using pMDI in the Chest Medical ward were checked correctly for operating procedures. After analyzing the causes for the low accuracy of pMDI operation, we formulated and implemented improving strategies from March to May. Then, the PDCA model was conducted to confirm the effect of each goal of establishing standard operating procedures.

Results: Twenty-two patients were recruited for the pre-check and the accuracy was 52.6%. By inspecting 19 patients and nurses, there were two true causes including lack of ”practice of operation skills” and “lack of auditing system for the consistency of nursing guidance”. The strategies which were discussed by brainstorming were: 1. Using revised pMDI device education process and nurse self-checklist; 2. Creating the mnemonic phrase for easily memorized; 3. Making operation step charts; 4. Innovate pMDI operation practice props “Jin-xi-li” (homophonic as “Nice inhalation skill” in Chinese ); 5. Making pMDI device education video upload - build QR CODE. After the strategies twenty-nine patients who used pMDI . The accuracy of pMDI increased from 52.6% to 95.8% after implementation, and the consistency of education was improved from 46.7% to 100%.

Conclusion: The implementation of various countermeasures in this period of activities has achieved good results, so it has been included in the standard work as a basis for clinical care. The performance of the circle members in this period of activities is that they can make good use of clinical resources, innovate countermeasures and practice tools, but if the response to the verification of the true cause and the suspension of activities due to the epidemic is insufficient, they can strengthen their study and training in the future.

References: Cho-Reyes, S., Celli, B. R., Dembek, C., Yeh, K., & Navaie, M. (2019). Inhalation Technique Errors with Metered-Dose Inhalers Among Patients with Obstructive Lung Diseases: A Systematic Review and Meta-Analysis of U.S. Studies. Chronic obstructive pulmonary diseases (Miami, Fla.), 6(3), 267–280. https://doi.org/10.15326/jcopdf.6.3.2018.0168

Chrystyn, H., van der Palen, J., Sharma, R., Barnes, N., Delafont, B., Mahajan, A., & Thomas, M. (2017). Device errors in asthma and COPD: systematic literature review and meta-analysis. NPJ primary care respiratory medicine, 27(1), 1-10.

Thomas, R. M., Locke, E. R., Woo, D. M., Nguyen, E. H., Press, V. G., Layouni, T. A., ... & Fan, V. S. (2017). Inhaler training delivered by internet-based home videoconferencing improves technique and quality of life. Respiratory care, 62(11), 1412-1422.

Keywords: drug safety, patient education, pressurized metered dose inhalers